Strabismus: Causes, Symptoms, Diagnosis and Treatment

Strabismus occurs frequently. In young children, such a defect can sometimes look touching and funny, but you can not underestimate the violations. At any age, this is an unpleasant pathology that needs to be corrected - from the point of view of medicine, and from the point of view of aesthetics. Although the overwhelming majority of cases are children, adults are also not protected from it.

In children, strabismus is, of course, easier to fix, especially if it is found at the very beginning of development, and treatment is started in a timely manner. Strabismus causes a lot of inconvenience to the patient, the mowing eye may eventually "completely fail", not to mention the psychological and aesthetic discomfort. Fortunately, diagnosing strabismus is very simple, and modern medicine provides a whole arsenal of means for its treatment, right up to the surgical operation, if necessary. What is strabismus? According to statistics, one child in fifty suffers from it. This is a defect associated with the uncoordinated activity of one or more eye muscles responsible for the movement of the eyeball.

If the eyes normally focus on a certain point, transmitting to the brain a picture from each eye, then with strabismus as a result of muscle weakness one eye deviates from this point, the image obtained from one eye does not correspond to the image obtained from the other. Because of this, the nervous system excludes the image obtained from the mowing eye, a three-dimensional image in the brain is not created. As a result, a person sees a flat image, and the eye, which mows, almost does not participate in the visual process, ceases to work. Because of this, over time, amblyopia develops, or lazy myopia, "lazy eyes," as sometimes called strabismus in children.

Causes of the disease may be different, but in any case, if you do not treat the sick eye, the visual acuity of his falls, he is generally excluded from participation in the visual process.

Types of strabismus

Causes of visual impairment may be different. As for strabismus, ophthalmologists consider congenital and acquired disease.

By species, strabismus is distinguished into a friendly and unfriendly.

Causes of congenital strabismus

In fact, congenital, in its pure form, strabismus occurs in isolated cases. If the strabismus develops in the first six months of life, it is called infantile. In such cases, the causes of the disease are genetic disorders, for example Cruson Syndrome and Down Syndrome;heredity - in this case, strabismus is diagnosed in the relatives of the first and second lines;birth defects of eyes, cerebral palsy. Often, the disease occurs as a result of the effects of prematurity, the effects on the fetus of various drugs and drugs, and if the mother during the pregnancy has had infectious diseases( measles, cytomegalovirus, ARVI and some others), it can also provoke a strabismus in the child.

Causes of Acquired Strabismus

The disease can develop after the first half of life and even in an adult. In this case, it is called acquired. The causes of acquired strabismus are numerous. First of all, the disease is provoked by medium and high degrees of myopia, hyperopia, astigmatism and sudden changes in vision without noticeable reasons. Also, strabismus can develop due to various violations of eye refraction: glaucoma, cataract, astigmatism and others. In addition, these are various eye diseases, including retinoblastoma, strabismus after trauma, swelling and other injuries.

Strabismus is the result of muscle paralysis, which accompanies certain diseases, for example encephalitis, multiple sclerosis, neurosyphilis, as well as somatic and mental illnesses. In addition, it is acquired if the eyeball is not sufficiently supplied with blood, intracranial pressure rises sharply, pathologies of the brain or spinal cord develop. Strabismus can appear as complications after the flu, measles, scarlet fever, diphtheria.

Severe fright can also cause strabismus in children. Causes of psychological nature, stressful situations, psycho traumas, nervous overstrain quite often lead to the fact that preschoolers( and sometimes even older children and even adults) start mowing.

Friendly strabismus

Friendly is a disease in which the angles of strabismus are the same. That is, it mows any one eye, but the magnitude of the deflection angle of the mowing eye( primary) and the angle of deviation of the healthy( secondary) are equal. Despite the fact that the muscular system of the eyes is developed in different ways, there is no double vision, both eyeballs are mobile in full measure.

Friendly strabismus is divided into three groups of visual impairment:

• Accommodation.

• Non-accommodation.

• Partially accommodation.

When accommodating strabismus, the disease is accompanied by a pathology of vision - farsightedness or nearsightedness. This type of strabismus develops at the age of 2-4 years. Corrected by wearing glasses.

Paralysis of muscles responsible for eye movement, cause non-accommodation strabismus. The causes of paralysis can be covered in problems during fetal development or diseases postponed after birth. This type of strabismus is difficult to determine at the initial stage. Often he accompanies cerebral palsy.

Sometimes:

• horizontal( when the eyes are directed in different directions - exotrophy, or divergent strabismus, when the eyes are directed to the bridge of the nose - isotropy, or convergent strabismus);
• vertical( when the eye is mowing up - hypertropy, when the eye is squinting down - hypotrophy);
• mixed( when combined with several forms of strabismus).

This type of strabismus is not corrected by points.

Varieties of non-accommodation strabismus:

• sensory( with the fall of one eye view);
• acute( strabismus, which suddenly arose after stress, psychotrauma or nervous tension);
• cyclic( strabismus occurs and disappears after a certain period of time, the cause is the violation of the central nervous system);
• secondary( strabismus, reversing direction after surgical or spectacle correction).

There is also a special kind of non-accommodation strabismus - the excess of divergence. In this case, the strabismus appears only when the person peers into the distance.

Partially accommodative strabismus combines the symptoms of accommodative and motor impairment, for example, fluctuations in eyeballs that appear involuntarily and regularly. It happens converging( when the eyes are focused on the bridge of the nose) and divergent( eyes "look" at the whiskey).

Strabismus can have a different degree of severity:

• strongly visualized has an angle of more than 37 degrees, the
• is well visible has an angle of 22-36 degrees,
• average is 11-21 degrees,
• is insignificant - 6-10 degrees,
• practically not expressed - angle less5 degrees.

Non-friendly strabismus

With unfriendly strabismus, the primary and secondary deviation angles are not the same. The mobility of the eye is thus limited or absent in one or more directions. Most often, the paralytic nature of origin, as a non-accommodation form, has this squint. The causes of this disease are lesions of the oculomotor nerves.

There is also a pseudo-paralytic strabismus. The causes of visual impairment in this case - anomalies of development or after surgery, but not the defeat of nerves.

Imaginary strabismus

All kinds of strabismus that have been described are true. They should not be confused with the apparent strabismus that occurs in young children. Because of their age, they are often unable to focus on the subject, which creates the appearance that the child is mowing.

However, imaginary temporary strabismus sometimes happens with adults. Usually it happens because of alcoholic intoxication.

Diagnosis

Even if it seems that strabismus is almost imperceptible or harmless, do not delay treatment. This is not a cosmetic defect, so it requires immediate attention once it is found. If the correction of strabismus is not carried out, the eye may lose the ability to see.

First symptoms of strabismus:

• deviation of one or both eyes to the nose( converging strabismus) or to the side( divergent strabismus),
• inability to focus on the subject( so-called floating look).

In this case, you need to take into account a lot of details, so as not to confuse the disease with the imaginary. For strabismus, you can take a special section of the eyes or their specific location, which is characteristic of a particular child. It is important to distinguish between the actual symptoms of strabismus from imaginary signs. These physiological signs most often disappear by themselves with age. Floating sight can be found in infants up to six months, which can not yet focus on the subject. This also goes with age. There are many parents who began to panic, suspected of strabismus in children under one year old, their excitement was dispelled either by specialists or by the disappearance of symptoms at a later age.

Parents often notice strabismus and turn to an ophthalmologist. This is the disease, which can be diagnosed virtually independently, without the help of a specialist.

The disease can also be detected with a planned examination of the child. The eye doctor performs diagnostics of the whole visual apparatus, including using a computer, conducts tests that confirm the absence of 3D vision and that the child has a squint. The causes of the disease must be clarified in order to prescribe a treatment suitable for this type of problem.

The doctor selects glasses or lenses, prescribes hardware treatment and, if necessary, medicines. In difficult cases, he can send an operation to an ophthalmological clinic.

If to start treatment at an early stage of development, in most cases it is possible to completely get rid of the disease.

Non-drug treatment

Strabismus in some cases is corrected using glasses or lenses. This method is shown for accommodative and partially accommodative strabismus.

With partially accommodative strabismus, Fresnel prisms are glued to the lens of glasses - complex composite lenses.

The pleoptics method is also successfully used, that is, treatment with occlusion. In this case, a bandage is put on a healthy eye or an eye patch is applied. Treatment should last at least 4 months and is shown mainly in the treatment of pediatric strabismus. With this method it is necessary to constantly monitor the visual acuity of a healthy eye, which is constantly stuck. For the treatment to be more effective, the pleoptics are combined with a hardware correction, which includes laser therapy, amblycopor, electrostimulation and other methods.

Medication and hardware treatment

Drugs are prescribed together with hardware treatment and gymnastics for the eyes and either relax the muscles and blunt vision, like atropine, or, like pilocarpine, prevent the narrowing of the pupil. The essence of the treatment is to increase the load on the eye and stimulate its active work.

The hardware is also effective in treating the disease. Such apparatuses as monobinoscope and synoptophor are used. The first irritates the retina with light rays and thereby fights against amblyopia( reduced vision) and double vision. The second is used for sensory strabismus in cases where the angle of strabismus is sufficiently large.

Patients also show orthopto-diploptic treatment, consisting of training exercises on the apparatus. Such treatment is aimed at the development of binocular vision.

Surgical treatment of

In some cases, strabismus is recommended for surgical intervention. Thanks to it, the muscle, which is responsible for the movement of the eyeball, is strengthened or weakened. Strabismus surgery is used if complex treatment has not helped. It is also shown in paralytic and non-encroachable forms.

With highly visualized strabismus, several operations can be performed on each eye with a break of at least six months.

In the case of strabismus, two types of operations are performed: resection, shortening the length of the eye muscle, and recession - movement of the eye muscle. The choice of the nature of the operation depends on the type of strabismus and its angle. Combined interventions can also be performed. They perform operations under general and under local anesthesia.

It is worth replacing that up to 3-4 years of surgical strabismus is not corrected. It is necessary to wait for binocular vision to form, that is, the ability to see the image of an object with both eyes. At an earlier age, surgical intervention is possible only if there is an inherent strabismus with a significant deflection angle. Only such an eye doctor as a surgeon can perform such operations.

After the operation, treatment should be continued by some other of the above methods to restore and strengthen binocular vision.